scholarly journals Evaluation of environmental cleaning quality: an observational study at a tertiary hospital in Wuhan, China

2021 ◽  
Vol 15 (09) ◽  
pp. 1252-1256
Author(s):  
Qiuxia Yang ◽  
Aijia Wang ◽  
Xinping Zhang ◽  
Xiaoquan Lai
Keyword(s):  
Observational Study ◽  
Public Hospital ◽  
Tertiary Hospital ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Environmental Cleaning ◽  
Process Indicators ◽  
Hospital Safety ◽  
Cleaning Staff

Introduction: The COVID-19 pandemic highlights the role of environmental cleaning in controlling infection transmission in hospitals. However, cleaning practice remains inadequate. An important component of effective cleaning is to obtain feedback on actual cleaning practice. This study aimed to evaluate the cleaning process quality from an implementation perspective. Methodology: An observational study was conducted in a tertiary public hospital in Wuhan, China and 92 cleaning processes of units housing patients with multidrug-resistant organism infections were recorded. The bed unit cleaning quality and floor cleaning quality were measured by six and five process indicators respectively. Descriptive statistics were used to describe the cleaning quality. Results: For bed unit cleaning quality, the appropriate rates of cleaning sequence, adherence to cleaning unit principle, use of cloth, use of cloth bucket, separation of clean and contaminated tools, and disinfectant concentration were 35.9%, 71.7%, 89.7%, 11.5%, 65.4%, and 48.7%, respectively. For floor cleaning quality, the appropriate rates of adherence to cleaning unit principle, use of cloth, use of cloth bucket, separation of clean and contaminated tools, and disinfectant concentration were 13.4%, 50.0%, 35.5%, 11.0%, and 36.7%, respectively. Conclusions: The cleaning staff showed poor environmental cleaning quality, especially the floor cleaning quality. The findings can help reveal deficiencies in cleaning practices, raise awareness of these deficiencies, and inform targeted strategies to improve cleaning quality and hospital safety.

Healthcare microenvironments define multidrug-resistant organism persistence

2021 ◽  
pp. 1-7
Author(s):  
Brendan J. Kelly ◽  
Selamawit Bekele ◽  
Sean Loughrey ◽  
Elizabeth Huang ◽  
Pam Tolomeo ◽  
...  
Keyword(s):  
16S Rrna ◽  
Hot Spots ◽  
Multidrug Resistant ◽  
Systematic Sampling ◽  
Resistant Organism ◽  
Rrna Gene ◽  
Environmental Cleaning ◽  
Healthcare Environment ◽  
Clostridioides Difficile ◽  
Modifiable Factors

Abstract Background: Multidrug-resistant organisms (MDROs) colonizing the healthcare environment have been shown to contribute to risk for healthcare-associated infections (HAIs), with adverse effects on patient morbidity and mortality. We sought to determine how bacterial contamination and persistent MDRO colonization of the healthcare environment are related to the position of patients and wastewater sites. Methods: We performed a prospective cohort study, enrolling 51 hospital rooms at the time of admitting a patient with an eligible MDRO in the prior 30 days. We performed systematic sampling and MDRO culture of rooms, as well as 16S rRNA sequencing to define the environmental microbiome in a subset of samples. Results: The probability of detecting resistant gram-negative organisms, including Enterobacterales, Acinetobacter spp, and Pseudomonas spp, increased with distance from the patient. In contrast, Clostridioides difficile and methicillin-resistant Staphylococcus aureus were more likely to be detected close to the patient. Resistant Pseudomonas spp and S. aureus were enriched in these hot spots despite broad deposition of 16S rRNA gene sequences assigned to the same genera, suggesting modifiable factors that permit the persistence of these MDROs. Conclusions: MDRO hot spots can be defined by distance from the patient and from wastewater reservoirs. Evaluating how MDROs are enriched relative to bacterial DNA deposition helps to identify healthcare micro-environments and suggests how targeted environmental cleaning or design approaches could prevent MDRO persistence and reduce infection risk.

Support services

2019 ◽  
pp. 428-484
Author(s):  
Nizam Damani
Keyword(s):  
Occupational Health ◽  
Support Services ◽  
Prevention And Control ◽  
Health Department ◽  
Multidrug Resistant ◽  
Environmental Cleaning ◽  
Practical Advice ◽  
Multidrug Resistant Pathogens ◽  
And Control

This section discusses the role of hospital support services in the prevention and control of infection. It examines the role and responsibilities of the occupational health department which include pre-employment assessment and provision of guidance on how to manage healthcare workers who are exposed and/or infected with various communicable diseases and multidrug-resistant pathogens. It outlines the importance of infections spread by contaminated environment and provides practical advice on the environmental cleaning. Advice on the management of clinical waste, kitchen and catering services, linen and laundry services, and pest control is also provided.

scholarly journals Multidrug-resistant Organisms in Hospitals: What Is on Patient Hands and in Their Rooms?

2019 ◽  
Vol 69 (11) ◽  
pp. 1837-1844 ◽  
Author(s):  
Lona Mody ◽  
Laraine L Washer ◽  
Keith S Kaye ◽  
Kristen Gibson ◽  
Sanjay Saint ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Healthcare Personnel ◽  
Resistant Organism ◽  
Dominant Hand ◽  
Paired Samples ◽  
Environmental Surfaces ◽  
Healthcare Associated ◽  
The Impact ◽  
Panton Valentine Leukocidin

AbstractBackgroundThe impact of healthcare personnel hand contamination in multidrug-resistant organism (MDRO) transmission is important and well studied; however, the role of patient hand contamination needs to be characterized further.MethodsPatients from 2 hospitals in southeast Michigan were recruited within 24 hours of arrival to their room and followed prospectively using microbial surveillance of nares, dominant hand, and 6 high-touch environmental surfaces. Sampling was performed on admission, days 3 and 7, and weekly until discharge. Paired samples of methicillin-resistant Staphylococcus aureus (MRSA) isolated from the patients’ hand and room surfaces were evaluated for relatedness using pulsed-field gel electrophoresis and staphylococcal cassette chromosome mec, and Panton-Valentine leukocidin typing.ResultsA total of 399 patients (mean age, 60.8 years; 49% male) were enrolled and followed for 710 visits. Fourteen percent (n = 56/399) of patients were colonized with an MDRO at baseline; 10% (40/399) had an MDRO on their hands. Twenty-nine percent of rooms harbored an MDRO. Six percent (14/225 patients with at least 2 visits) newly acquired an MDRO on their hands during their stay. New MDRO acquisition in patients occurred at a rate of 24.6/1000 patient-days, and in rooms at a rate of 58.6/1000 patient-days. Typing demonstrated a high correlation between MRSA on patient hands and room surfaces.ConclusionsOur data suggest that patient hand contamination with MDROs is common and correlates with contamination on high-touch room surfaces. Patient hand hygiene protocols should be considered to reduce transmission of pathogens and healthcare-associated infections.

scholarly journals Intra-abdominal Infections: The Role of Anaerobes, Enterococci, Fungi, and Multidrug-Resistant Organisms

2016 ◽  
Vol 3 (4) ◽  
Author(s):  
Gil Marcus ◽  
Samuel Levy ◽  
Ghaleb Salhab ◽  
Bethlehem Mengesha ◽  
Oran Tzuman ◽  
...  
Keyword(s):  
Roc Curve ◽  
Operating Characteristic ◽  
Medical Center ◽  
Hospital Setting ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Multidrug Resistant Organisms ◽  
Abdominal Infections ◽  
Healthcare Associated

Abstract Background Intra-abdominal infections (IAI) constitute a common reason for hospitalization. However, there is lack of standardization in empiric management of (1) anaerobes, (2) enterococci, (3) fungi, and (4) multidrug-resistant organisms (MDRO). The recommendation is to institute empiric coverage for some of these organisms in “high-risk community-acquired” or in “healthcare-associated” infections (HCAI), but exact definitions are not provided. Methods Epidemiological study of IAI was conducted at Assaf Harofeh Medical Center (May–November 2013). Logistic and Cox regressions were used to analyze predictors and outcomes of IAI, respectively. The performances of established HCAI definitions to predict MDRO-IAI upon admission were calculated by receiver operating characteristic (ROC) curve analyses. Results After reviewing 8219 discharge notes, 253 consecutive patients were enrolled (43 [17%] children). There were 116 patients with appendicitis, 93 biliary infections, and 17 with diverticulitis. Cultures were obtained from 88 patients (35%), and 44 of them (50%) yielded a microbiologically confirmed IAI: 9% fungal, 11% enterococcal, 25% anaerobic, and 34% MDRO. Eighty percent of MDRO-IAIs were present upon admission, but the area under the ROC curve of predicting MDRO-IAI upon admission by the commonly used HCAI definitions were low (0.73 and 0.69). Independent predictors for MDRO-IAI were advanced age and active malignancy. Conclusions Multidrug-resistant organism-IAIs are common, and empiric broad-spectrum coverage is important among elderly patients with active malignancy, even if the infection onset was outside the hospital setting, regardless of current HCAI definitions. Outcomes analyses suggest that empiric regimens should routinely contain antianaerobes (except for biliary IAI); however, empiric antienterococcal or antifungals regimens are seldom needed.

scholarly journals MON-626 Frequency and Associated Factors with Multidrug-Resistant Organism Infection in Diabetic Foot Ulcers in a Peruvian Public Hospital

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Marlon Augusto Yovera-Aldana ◽  
Liset Paola Sifuentes ◽  
Delia Cruz-Estacio ◽  
Diana Consuelo Flores ◽  
Lucy Nelly Damas-Casani
Keyword(s):  
Clinical Practice ◽  
Diabetic Foot ◽  
Associated Factors ◽  
Public Hospital ◽  
Multidrug Resistant ◽  
Foot Ulcers ◽  
Bivariate Analysis ◽  
Resistant Organism ◽  
Diabetic Foot Ulcers ◽  
International Expert

Abstract Objective: To determine the frequency and associated factors with multidrug-resistant organism (MDRO) infection among patients with diabetic foot ulcers in a Peruvian Public Hospital. Materials and methods. Cross-sectional survey was conducted from January 2017 -December 2018 at National Hospital in Lima Perú. Ulcers with clinical signs of infection (erythema, edema, pain, purulent exudate) according Infectious Diseases Society of America clinical practice guideline were included1. Wounds with only skin involvement were excluded. On admission, specimens for culture were obtained after cleansing and debriding of the wound. Samples were promptly sent to the microbiology laboratory for culture using appropriate transport media. Bacterial identification and antibiotic susceptibility testing were performed using the VITEK® 2 automated system (BioMérieux Laboratory, Argentina). Multidrug-resistant organisms were identified according to the recommendations of International Expert Proposal2. Prevalence ratios derived from bivariate analysis are given with their 95% CI, which was performed to study factors associated with the presence of multidrug-resistant bacteria; and a multivariate analysis with a lineal model to associated variables found in the bivariate analysis. This study has the approval of the Research Ethics Committee of the María Auxiliadora Hospital. Results Among 153 selected subjects, 75% were male, with an average age of 59 yo, 70% had ≥10 years of diabetes duration and only 16% had HbA1C <7%. A frequency of 85% of patients with MDRO infection was found and was associated with minor amputation RP 1.18 (95% CI 1.01-1.44) and with hospitalization time of ≥ 28 days RP 1.21 (95% CI 1.03-1.30). Conclusion. 6 of 7 patients have MDRO infection among patients with diabetic foot ulcers and are associated with the occurrence of minor amputation and hospitalization time ≥ 28 days. References 1. Lipsky BA, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132-73. 2. Magiorakos AP, et al. Multidrug-resistant, extensively drug-resistant and pandrugresistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81.

scholarly journals Role of efflux pumps inhibitor in decreasing antibiotic resistance of Klebsiella pneumoniae in a tertiary hospital in North India

2015 ◽  
Vol 9 (08) ◽  
pp. 815-820 ◽  
Author(s):  
Joel Filgona ◽  
Tuhina Banerjee ◽  
Shampa Anupurba
Keyword(s):  
Klebsiella Pneumoniae ◽  
Efflux Pumps ◽  
Tertiary Hospital ◽  
Multidrug Resistant ◽  
North India ◽  
Resistant Bacteria ◽  
Disk Diffusion Test ◽  
Carbapenem Resistant ◽  
Agar Dilution

Introduction: The contribution of efflux systems to drug resistance in Enterobacteriaceae is becoming increasingly appreciated. This study phenotypically analyzed the role of efflux mechanisms in resistance to ertapenem, doripenem, and tigecycline among clinical isolates of carbapenem-resistant Klebsiella pneumoniae (CRKP). Methodology: Multidrug-resistant and carbapenem non-susceptible K. pneumoniae isolates were determined by disk diffusion test. Further susceptibility of these isolates to carbapenems, ceftriaxone, cefoperazone, ceftazidime, tigecycline, and colistin was determined by agar dilution assay, and CRKP was identified. While modified Hodge test was used to confirm carbapenemase production, the contribution of efflux mechanisms was determined by a minimum inhibitory concentration (MIC) reduction assay, and typing was done by enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction (PCR). Results: Of the 238 isolates of K. pneumoniae, 174 were multidrug resistant and 74 were CRKP. Forty of the CRKP were positive for carbapenemase production, while 43, 11, and 2 of the CRKP isolates had elevated MIC of ≥ 32 µg/mL for ertapenem, doripenem, and tigecycline, respectively. Twofold or higher MIC reduction to ertapenem, doripenem, and tigecycline was observed in 6, 28, and 27 isolates, respectively; however, non-susceptibility to ertapenem, doripenem and tigecycline was abolished in 2, 11, and 18 K. pneumoniae isolates, respectively. Nine clones of CRKP widely distributed within the hospital were obtained from ERIC PCR. Conclusions: Although colistin retained better activity against CRKP, efflux pumps contributed to increased MIC in ertapenem, doripenem, and tigecycline. Therefore, efflux systems are important aspects that should be explored in the fight against multidrug-resistant bacteria.  

scholarly journals Preventing the Transmission of Multidrug-Resistant Organisms: Modeling the Relative Importance of Hand Hygiene and Environmental Cleaning Interventions

2014 ◽  
Vol 35 (9) ◽  
pp. 1156-1162 ◽  
Author(s):  
Sean L. Barnes ◽  
Daniel J. Morgan ◽  
Anthony D. Harris ◽  
Phillip C. Carling ◽  
Kerri A. Thom
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Environmental Cleaning ◽  
Control Programs ◽  
Hospital Units ◽  
Hygiene Compliance ◽  
Using Data ◽  
Intensive Care Unit Nurses

ObjectiveHand hygiene and environmental cleaning are essential infection prevention strategies, but the relative impact of each is unknown. This information is important in assessing resource allocation.MethodsWe developed an agent-based model of patient-to-patient transmission—via the hands of transiently colonized healthcare workers and incompletely terminally cleaned rooms—in a 20-patient intensive care unit. Nurses and physicians were modeled and had distinct hand hygiene compliance levels on entry and exit to patient rooms. We simulated the transmission of Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci for 1 year using data from the literature and observed data to inform model input parameters.ResultsWe simulated 175 parameter-based scenarios and compared the effects of hand hygiene and environmental cleaning on rates of multidrug-resistant organism acquisition. For all organisms, increases in hand hygiene compliance outperformed equal increases in thoroughness of terminal cleaning. From baseline, a 2∶1 improvement in terminal cleaning compared with hand hygiene was required to match an equal reduction in acquisition rates (eg, a 20% improvement in terminal cleaning was required to match the reduction in acquisition due to a 10% improvement in hand hygiene compliance).ConclusionsHand hygiene should remain a priority for infection control programs, but environmental cleaning can have significant benefit for hospitals or individual hospital units that have either high hand hygiene compliance levels or low terminal cleaning thoroughness.Infect Control Hosp Epidemiol 2014;35(9):1156-1162

Sign in / Sign up

Export Citation Format

Share Document